HomeMy WebLinkAbout1983-05-20 Permit, Water Well #6998GENERAL PERMIT CITY PERMIT NO. _-6990 1
CITY OF ORONO
P,O.BOX 66 Date S — a G
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner ,.k �u.a.��,.. Address _ 3 6 F&AtYdJLR �—
Contractor _- �T e-t�t -� - Address /S 3 d (0 7
City Licease No
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION
Inside Plumbing ( M fixtures ) Fee S
Water Meter (Size ) Fee S
Meter #
Remote #f
Municipal Water Connection Fee S
❑ Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast ❑—__
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned hereby aeknowtedges receipt of this limited
permit. including aecsptande of ali special information,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work,
activil• or improvement specified: that this permit does
not p'uvt any authority to do •.ork or activities requiring
s "ate nermtt approvals. and that this permit does not
Grant au thonty to vi"late any provision of any Citv
urdmance or State lsw, rule or regulation. All work shut be
done in strict compliance with all City ordinances, buticimit
codes and/or health department regulations, and shall be
w+bioet to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be ut violation of the conditions of
this permit.
SignaWn ul' Applicant
State License No.
❑ REPAIR
On Site Septic System Fee S
Water Well Fee S 90 a G0
Mechanical Equipment Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge: Fee S e SO
Total Amount Paid to City Fee S a(J it 60
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatur, of City Official
Code White file Copy Canary Insptti tnr'v C"pv — Pink I inance Copy Gold Applicant's Receipt